Provider Demographics
NPI:1568520088
Name:LEVY, RENEE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:LEVY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10911 NW 39TH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7558
Mailing Address - Country:US
Mailing Address - Phone:754-581-4074
Mailing Address - Fax:
Practice Address - Street 1:10911 NW 39TH ST APT 102
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7558
Practice Address - Country:US
Practice Address - Phone:754-581-4074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102563363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2918307Medicaid
Q54212Medicare UPIN